Acta Chir Orthop Traumatol Cech. 2015; 82(1):22-32 | DOI: 10.55095/achot2015/003
Management of Femoral Shaft FracturesCurrent concepts review
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University of Freiburg Medical Center, Freiburg, Germany
Femoral shaft fractures are severe injuries and are often associated with a high impact trauma mechanism, frequently seen in multiple injured patients. In contrast an indirect trauma mechanism can lead to a complex femoral shaft fracture especially in elderly patients with minor bone stock quality. Hence management of femoral shaft fractures is often directed by co-morbidities, additional injuries and the medical condition of the patient. Timing of fracture stabilization is depended on the overall medical condition of the patient, but definite fracture fixation can often be implemented in the early total care concept in management of multiple injured patients.
The treatment of choice is intramedullary fracture fixation. Further development of existing intramedullary nailing systems now offer comfortable handling and different locking options. Ipsilateral fractures of the neck and shaft are therefore facilitated in management. Then again increasing numbers of obese patient are representing a new patient group with challenging co-factors in fracture management.
Sufficient preoperative planning is helpful to choose the most adequate fixation device. Correct reduction of the fracture and perioperative control of the axis and rotation is mandatory to avoid postoperative malrotation, which still represents the most frequent complication.
Published: February 1, 2015 Show citation
References
- Arneson, T. J., Melton, L. J., Lewallen, D. G. III, O'Fallon, W. M.: Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. Clin. Orthop. Relat. Res., 234: 188-194, 1988.
Go to original source...
- Court-Brown, C. M., Rimmer, S., Prakash, U., McQueen, M. M.: The epidemiology of open long bone fractures. Injury, 29: 529-534, 1998.
Go to original source...
Go to PubMed...
- Craig, N. J. A., Sivaji, C., Maffulli, N.: Subtrochanteric fractures. A review of treatment options. Hospital for Joint Diseases, 60: 35-46, 2001.
- Dickson, K. F., Galland, M. W., Barrack, R. L., Neitzschmann, H. R., Harris, M. B., Myers, L., Vrahas, M. S.: Magnetic resonance imaging of the knee after ipsilateral femur fracture. J. Orthop. Trauma, 16: 567-571, 2002.
Go to original source...
Go to PubMed...
- Duncan, C. P., Haddad, F. S.: The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J., 96-B: 713-716, 2014.
Go to original source...
Go to PubMed...
- Duncan, C. P., Masri, B. A.: Fractures of the femur after hip replacement. Instr. Course Lect., 44: 293-304, 1995.
- Dunham, C. M., Bosse, M. J., Clancy, T. V., Cole, F. J. jr., Coles, M. J., Knuth, T., Luchette, F. A., Ostrum, R., Plaisier, B., Poka, A., Simon, R. J.: Practice management guidelines for the optimal timing of long-bone fracture stabilization in polytrauma patients: the EAST Practice Management Guidelines Work Group. J. Trauma, 50: 958-967, 2001.
Go to original source...
Go to PubMed...
- GÄnsslen, A., GÖsling, T., Hildebrand, F., Pape, H. C., Oestern, H. J.: Femoral shaft fractures in adults: treatment options and controversies. Acta Chir. orthop Traum. èech., 81: 108-117, 2014.
Go to original source...
- Giesing, T., Illing, P.: AWMF Leitlinien der Femurschaftfrakturen. Deutsche Gesellschaft fuer Kinderchirurgie, 2010.
- Gustilo, R. B., Anderson, J. T.: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J. Bone Jt Surg., 58-A: 453-458, 1976.
Go to original source...
- HÜfner, T., Citak, M., Suero, E. M., Miller, B., Kendoff, D., Krettek, C., Citak, M.: Femoral malrotation after unreamed intramedullary nailing: an evaluation of influencing operative factors. J. Orthop. Trauma, 25: 224-227, 2011.
Go to original source...
Go to PubMed...
- Krettek, C., Gluer, S., Schandelmaier, P., Tscherne, H.: Intramedullary nailing of open fractures. Orthopade, 25: 223-233, 1996.
Go to original source...
Go to PubMed...
- Kuntscher, G.: Dauerbruch und Umbauzone: Bruns Beitrage. Klin. Chir., 169: 558, 1939.
- Lögters, T., Windolf, J., Flohe, S.: Fractures of the shaft of the femur. Unfallchirurg, 112: 635-651, 2009.
Go to original source...
Go to PubMed...
- Markmiller, M., Konrad, G., SÜdkamp, N.: Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin. Orthop. Relat. Res., 426: 252-257, 2004.
Go to original source...
Go to PubMed...
- Mehlhorn, A. T., Strohm, P. C., MÜller, C. A., Konstantinidis, L., Schmal, H., SÜdkamp, N. P.: The reversed locked internal plate fixator as an alternative internal fixation of problematic proximal femur fractures. Z. Orthop. Unfall., 147: 561-566, 2009.
Go to original source...
Go to PubMed...
- MÜller, M. E., AllgÖwer, M., Schneider, R., Willenegger, H.: Manual der Osteosynthese. AO Technik, 3. Auflage, Berlin Heidelberg New York, Springer 1992.
Go to original source...
- Nahm, N. J., Vallier, H. A.: Timing of defnitive treatment of femoral shaft fractures in patients with multiple injuries. A systematic review of randomized and nonrandomized trials. J. Trauma Acute Care Surg., 73: 1046-1063, 2012.
Go to original source...
Go to PubMed...
- Ostrum, R. F., Agarwal, A., Lakatos, R., Poka, A.: Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J. Orthop. Trauma, 14: 496-501, 2000.
Go to original source...
Go to PubMed...
- O'Toole, R. V., Riche, K., Cannada, L. K., Hennessy, M., Sciadini, M. F., Shi, L. L., Woodford, M., Harris, M. B.: Analysis of prospective knee sepsis after retrograde nail insertion of open femoral shaft fractures. J. Orthop. Trauma, 24: 677-682, 2010.
Go to original source...
Go to PubMed...
- Pape, H. C., Rixen, D., Morley, J., Husebye, E. E., MÜller, M., Dumont, C., Gruner, A., Oestern, H. J., Bayeff-Filoff, M., Garving, C., Pardini, D., van Griensven, M., Krettek, C., Giannoudis, P.; EPOFF Study Group: Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann. Surg., 246: 491-501, 2007.
Go to original source...
Go to PubMed...
- Parvizi, J., Jain, N., Schmidt, A. H.: Periprosthetic knee fractures. J. Orthop. Trauma, 22: 663-671, 2008.
Go to original source...
Go to PubMed...
- Ricci, W. M., Bellabarba, C., Evanoff, B., Hersovici, D., DiPasquale, T., Sanders, R.: Retrograde versus antegrade nailing of femoral shaft fractures. J. Orthop. Trauma, 15: 161-169, 2001.
Go to original source...
Go to PubMed...
- Ricci, W. M., Schwappach, J., Tucker, M., Coupe,, A., Brandt, K., Sanders, R., Leighton, R.: Trochanteric versus piri-formis entry point for the treatment of femoral shaft fractures. J. Orthop. Trauma, 20: 663-667, 2006.
- Rixen, D., Grass, G., Sauerland, S., Lefering, R., Raum, M. R., Yucel, N., Bouillon, B., Neugebauer, E. A.: Evaluation of criteria for temporary external fixation in risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients: ''evidence-based medicine'' versus ''reality'' in the trauma registry of the German Trauma Society. J. Trauma, 59: 1375-1395, 2005.
Go to original source...
Go to PubMed...
- Rizzoli, R., Akesson, K., Bouxsein, M., Kanis, J. A., Napoli, N., Papapoulos, S., Reginster, J.-Y., Cooper, C.: Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report. Osteoporoses Int., 22: 373-390, 2011.
Go to original source...
Go to PubMed...
- Rorabeck, C. H., Taylor, J. W.: Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop. Clin. North Am., 30: 209-214, 1999.
Go to original source...
Go to PubMed...
- Ruedi, T. P., Buckley, R. E., Moran, C. G.: AO principles of fracture management. 2nd edition, Stuttgart New York, Thieme 2002, 767-785.
- Samford, M. P., van den Beckerom, M. P. J., Kloen, P.: Operative treatment for femoral shaft nonunions. A systematic review of the literature. Strat. Traum. Limb. Recon., 8: 77-88, 2013.
Go to original source...
Go to PubMed...
- Scalea, T. M., Boswell, S. A., Scott, J. D., Mitchell, K. A., Kramer, M. E., Pollack, A. N.: External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J. Trauma, 48: 613-623, 2000.
Go to original source...
Go to PubMed...
- Schmal, H., Strohm, P. C., Mehlhorn, A. T., Hauschild, O., SÜdkamp, N. P.: Management of ipsilateral femoral neck and shaft fractures. Unfallchirurg 111: 886-891, 2008.
Go to original source...
Go to PubMed...
- Slongo, T., Audige, L., Schlickewei, W., Clavert, J.-M., Hunter, J.: Development and validation of the AO Pediatric Comprehensive Classification of Long Bone Fractures by the Pediatric Expert Group of the AO Foundation in Collaboration With AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology. J. Pediatr. Orthop., 26: 43-49, 2006.
Go to original source...
Go to PubMed...
- Streubel, P. N., Gardner, M. J., Ricci, W. M.: Management of femur shaft fractures in obese patients. Orthop. Clin. North Am., 42: 21-35, 2011.
Go to original source...
Go to PubMed...
- Teo, B. J. X., Koh, J. S. B., Goh, S. K., Png, M. A., Chua, D. T. C., Howe, T. S.: Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy. Bone Joint J., 96-B: 658-64, 2014.
Go to original source...
Go to PubMed...
- Tornetta, P. 3rd, Tiburzi, D.: Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial. J. Bone Jt Surg., 82-B: 652-654, 2000.
Go to original source...
- Tscherne, H., Oestern, H. J.: A new classification of soft-tissue damage in open and closed fractures. Unfallheilkunde, 85:111-115, 1982.
Go to PubMed...
- Weiss, R. J., Montgomery, S. M., Al Dabbagh, Z., Jansson, K. A.: National data of 6409 Swedish inpatients with femoral shaft fractures: Stable incidence between 1998 and 2004. Injury, 40: 304-308, 2009.
Go to original source...
Go to PubMed...
- Wendal, K., Runkel, M.: Systemic complications in intramedullary nailing. Orthopade, 25: 292-299, 1996.